SCRIPT NUMBER 70
GOUT
(ONE SPEAKER)
PROGRAM NAME: HEALTH NUGGETS
PROGRAM TITLE: GOUT
PROGRAM NUMBER: 70
SUBJECT: CAUSES, RISK FACTORS, PREVENTION OF GOUT ATTACKS
KEY WORDS: URIC ACID, KIDNEY STONES, TOFU, HIGH FRUCTOSE CORN
SYRUP, ALTERNATIVE THERAPY
DATE OF SCRIPT: JULY 27, 2012
AUTHOR: RICHARD YUKL, MD, FACS
Gout is a significant form of arthritis, accounting for approximately 5% of all
arthritis cases. It is characterized by sudden, severe attacks of pain, redness and
swelling in your joints, particularly the large joints of your big toes. It can also
occur in the joints of your ankles, knees, hands or wrists. Attacks are always
sudden, occurring without warning, often in the middle of the night. An acute
attack of gout can awaken you with the sensation that your big toe is on fire. The
affected joint is hot, swollen and so tender that even the weight of the sheet on it
can seem intolerable. The pain is likely to be most severe in the first 12 to 24
hours after it begins, but lingering discomfort lasting from a few days to a few
weeks may continue after the most severe pain subsides, and the affected joints
will remain swollen, tender and red.
Your liver produces uric acid when it breaks down certain of the foods you have
eaten, foods such as red meat, especially liver, sea food such as anchovies or
herring, and other foods such as asparagus, mushrooms and red wine. Normally,
this uric acid dissolves in your blood and passes through your kidneys into your
urine. If, however, your body produces too much uric acid or your kidneys are
unable to filter it fast enough, the uric acid levels in your blood build up, forming
crystals. Gout is caused by the buildup of uric acid crystals in your joints. These
crystals are sharp and needle-like. They settle in your joints or surrounding
tissues, and there they cause the pain, inflammation, stiffness and swelling.
What you eat is the most important factor relating to gout attacks. Factors that
will increase your uric acid level other than your diet include lifestyle factors such
as drinking excessive alcohol. More than two drinks a day for men, and more
than one a day for a woman, has been shown to increase the risk of gout attacks.
Also, some diseases and conditions increase your risk. These include untreated
high blood pressure, high fat and cholesterol levels in your blood, arteries
narrowed by cholesterol plaque, and chronic conditions such as diabetes.
If other members of your family have had gout attacks, you are at an increased
risk as well, because a genetic abnormality causes the liver of people in some
families to overproduce uric acid. Female hormones protect women against
suffering gout attacks because female hormones help to filter uric acid from the
blood into the urine. As women age, however, their levels of female hormones
decrease with menopause, and they become increasingly susceptible to attacks.
People with gout are prone to have multiple attacks. Left untreated, uric acid
crystals will eventually form under the skin where they will become swollen and
tender during gout attacks. Collections of these crystals can also accumulate in
your kidneys and urinary tract, causing kidney stones.
What should you do if you awaken with an acute gout attack? Your doctor will
prescribe certain powerful medicines to decrease the inflammation and pain,
medicines to block the production of uric acid by your liver, and other medicines
to improve your kidney’s ability to filter uric acid from your blood.
Some changes in your diet and lifestyle can be helpful. The American Dietetic
Association has guidelines that you can follow at home during an attack. Drink 8
to 16 cups of fluid a day. That’s 2 to 4 liters of fluids every day, with at least half
of that volume being water. Avoid drinking alcohol. Decrease the amount of
protein you eat, and be sure that protein comes from healthy sources such as
low-fat or fat-free milk products, tofu, and nut butters. Finally, limit your daily
intake of meat, fish and chicken to 4 to 6 ounces, or 113 to 170 grams, per day.
Eggs, by themselves, do not increase your risk of a gout attack.
During symptom-free periods, there are dietary guidelines that may help protect
you from suffering future gout attacks. First, keep your fluid intake high. Aim for 8
to 16 cups, or about 2 to 4 liters, of fluid each day, with at least half that volume
being water. Limit how many sweetened beverages you drink, especially those
drinks sweetened with high fructose corn syrup. Next, limit or avoid drinking
alcohol. Recent evidence suggests that beer in particular increases your risk of a
gout attack, especially in men. Importantly, eat a balanced diet. Your daily diet
should emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk
products. Eating meat, fish and chicken is associated with increasing the
likelihood of developing an acute gout attack, so limit your use of these foods.
Finally, maintain a desirable body weight. Choose food portions that allow you to
maintain a healthy weight. Losing weight will decrease uric acid levels in your
body. If you diet to lose weight, however, avoid fasting or overly rapid weight
loss, since such extreme changes may temporarily raise your uric acid level and
your risk of an attack.
If the gout treatments you try fail to relieve your gout pain as well as you'd
hoped, talk to your doctor concerning alternative therapies. Unfortunately, there
isn't a lot of research on alternative therapies for gout, so the risks may not be
completely known. Alternative therapies that include relaxation techniques such
as deep-breathing exercises and meditation may help take your mind off your
pain. Eating cherries and other dark-colored fruits, such as blackberries,
blueberries, purple grapes and raspberries have been associated with lower
levels of uric acid in studies, and they may be a safe way to supplement your
medical gout treatment. If you consider alternative therapies, discuss them with
your doctor.
Health Nuggets is written by Dr. Richard Yukl, a medical doctor working in the
United States. The medical views expressed in this program are his and may
differ for your particular health needs. If you need medical advice, please consult
a medical professional in your area.